Intestinal Disorders

Question 1

Define irritable bowel syndrome

Answer 1

Functional bowel disorder where the gut is extra sensitive (heightened visceral sensitivity) but structurally normal.

Question 2

How is IBS diagnosed?

Answer 2

Diagnosis on exclusion (there is no single test to diagnose IBS, it is diagnosed after ruling out all other possible conditions like celiac, Crohn’s, infections).

Question 3

What gender is more affected by IBS?

Answer 3

Women are more affected than men

Question 4

Clinical presentation of IBS

Answer 4

• Chronic abdominal pain/discomfort
• Chaotic bowel motility (constipation/diarrhea)

Question 5

Rome IV criteria for IBS

Answer 5

Recurrent abdominal pain at least 1x per week (on average) over the last 3 months associated with at least 2 of the following:
- Related to defecation (pain improves or worsens after defecation)
- Change in stool frequency (diarrhea or constipation)
- Change in stool form (appearance, loose hard or mixed)

Question 6

Describe the pathophysiology of appendicitis

Answer 6

1. Obstruction (fecalith, lymphoid hyperplasia) of the appendix leads to bacterial overgrowth and increased intraluminal pressure.
2. Inflammation, resulting in mucosal and bowel wall edema
3. Vascular compromise - venous outflow is obstructed first, causing more congestion and swelling; arterial inflow is eventually compromised, causing ischemia
4. Necrosis caused by prolonged ischemia, can result in perforation

Perforation can result in a local abscess or peritonitis.

Question 7

Symptoms of appendicitis

Answer 7

• Epigastric/periumbilical pain
• Nausea and vomiting
• Pain migrates to the RLQ and becomes sharp/well-localized as peritoneum is inflamed (parietal)

Question 8

3 signs of appendicitis

Answer 8

• McBurney’s sign
• Rosvig’s sign
• Peritonitis

Question 9

McBurney’s Sign

Answer 9

Tenderness 2/3 of the way between the ASIS and umbilicus

Question 10

Rosvig’s Sign

Answer 10

Palpating the equivalent of McBurney’s point in the LLQ triggers pain in the RLQ

Question 11

Peritonitis signs

Answer 11

Rebound tenderness, guarding, rigidity

Question 12

How doe we normally diagnose appendicitis? How do we diagnose it in pregnant women and children?

Answer 12

Normal: abdominal CT
Pregnant women/children: abdominal US

Question 13

2 complications of appendicitis

Answer 13

1. Perforatio and peritonitis (sepsis, shock)
2. Peri-appendiceal abscess

Question 14

Appendicitis treatment (2)

Answer 14

1. Appendectomy
2. Possible conservative management with antibiotics alone

Question 15

What is the difference between true and false diverticula?

Answer 15

True: All 3 layers of bowel wall (e.g. appendix, Meckel’s)
False: mucosa and submucosa only

Question 16

What are colonic polyps (adenomas)?

Answer 16

Neoplastic masses protruding into the colon

Question 17

Colonic polyps are at highest risk of malignant transformation if… (3)

Answer 17

1. Villous histology
2. Sessile growth
3. Increased size